Blog for Rural America

Under What-ing?

Until I started the process of applying for a mortgage, I had never really considered what underwriting was. I knew underwriting had something to do with considering risk and that you found it in finance and insurance. That was about the extent of my knowledge.

Now I know that within the context of my mortgage, an underwriter's job was to collect all of my important financial statistics and decide whether I had the means to pay back the money I borrowed. Lucky for me, they decided I was a good risk.

Underwriting has gained some attention recently due to the role underwriters play in health insurance, but this time their role is more sinister in its outcome. A health insurance underwriter takes my health information and weighs what they see as the chances of me getting sick. If they decide I'm a high risk, they'll charge me more. If the risk is too high, they'll reject me.

The problem with this plan, however, is that health insurance companies set the bar so low that almost no one is considered a low risk. Perhaps this is why they've had record profits, with stocks rising 428% from 2000-2007.

It is an industry sector badly in need of regulation, as this article from Slate.com points out:

How badly are these reforms needed? To find out, I read through a 2009 document that BlueCross BlueShield of Texas provided its agents to guide them about who may and may not purchase a policy, and on what terms. The underwriting guidelines are quite draconian, though not dramatically worse than others that have leaked out...

The first hurdle to clear concerns weight...The next hurdle is much higher. It's called (with a refreshing absence of euphemism) the Automatic Decline List, and it consists of 143 diseases, from Addison's Disease to periarteritis nodosa, that will immediately disqualify you for coverage. It's "not all inclusive," we are warned, but if a potential customer has any of these then the agent must show him the door. Hemophilia? Disqualified. Penile implant? Get lost, you sissy! Pregnant? Begone, slattern, until after your post-partum checkup. Organ transplant? Unless it was your cornea, we got nothing to talk about...

Moving on to the Standard Rate Condition List of things that disqualify you for the preferred (but not standard) rate, I see "Anxiety/depression" (I'm busted), "GERD (acid reflux)," "Headache" (presumably that means more than the usual kind), "Herpes," "Temporomandibular Joint Disorder," "Tobacco use" (that's fair), and "Tourette's Syndrome" (the handbook offers no guidance about what a Tourette's sufferer is likely to say once he's been broken the bad news).

A few years ago, I was a healthy, non-smoking and active 25-year-old. When I found myself suddenly laid off from a small non-profit that didn't have a COBRA option, I tried to purchase it on the individual market.

Denied.

They claimed the occasional headaches I got disqualified me from coverage. No matter that my doctor wrote a letter on my behalf saying that in her professional medical opinion, there was nothing troublesome about an occasional headache.

After reading Timothy Noah's full piece, I wondered as he did how anyone is eligible under these underwriting rules.

Most of these restrictions would become illegal if health reform becomes law. To balance the fact that this would suddenly make lots of "risky" people eligible for insurance, the reforms also require that healthy people get covered too.

Reform sounds better all the time.
 

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Resources for Rural Groceries

A few months ago when we at the Center for Rural Affairs got the idea to do a series on rural grocery stores, I had no idea the interest that the articles would generate. Of all the things I've written in my year and a half at the Center, this has gotten by far the most response.

I couldn't be happier to see that other rural community members see their grocery store as an integral part of their town.

Here at the Center, we value contact with our supporters and do our best to respond to your needs. Because of the interest generated from these articles, we've launched a new page on our website dedicated to news stories, blog posts, and resources related to rural grocery stores.

Here's the link: http://www.cfra.org/renewrural/grocery

On this page, you'll find information, resources and ideas about the preservation of the rural grocery store. You see newspaper stores about other towns across the country, like La Junta, Colorado; Truman, Minnesota; and Stapleton, Nebraska.

You'll also find links to other web pages we find useful, like the Rural Grocery Store Initiative at Kansas State University and links to various federal programs that can be used to support grocery stores.

If you're feeling discouraged, you can always watch this video of Nick Graham, dubbed America's Youngest Grocer. Personally, I always feel better after listening to that kid's can-do attitude.

Do you have questions you'd like answered or articles, resources, strategies and stories to share with others who see the value of grocery stores in small towns? Consider joining our listserv on rural grocery stores, which you can do by sending me an email and mentioning the rural grocery store list.

So check out the new page, and I hope to hear from more of you soon!

 

Addressing All the Components of Local Food

These days it seems the most popular person to be in the food system is the "local farmer". Farmers markets are popping up everywhere, and their size and popularity grow all the time. Local food is trendy - even the First Family is in on it.

But as anyone who has ever raised grain or livestock can tell you, the farmer is not the only person in the chain of players from her farm to your fork. In addition to producers, your food chain includes processors, distributors or transporters, and retailers.

In other words, to have a truly local food system, we also need local butchers, bakers and millers, local truck drivers, local grocers, and a community that supports them in all their efforts.

In the world of farm and food policy, we've paid a lot of attention to production end of the food system. It's an obvious place to start. We have programs within the Farm Bill to develop new or "beginning" farmers, help them secure loans and down payments, and transition to organic agriculture. But most products aren't made to eat directly out of the field. Even salad greens or apples, things we typically eat raw and straight from the field, must be washed and sorted before your local farmer will sell them.

As Tom Philpott pointed out in early November, the infrastructure for small-scale processing is woefully inadequate, having suffered decades of atrophy - to the point where an otherwise profitable farmer can be driven out of business because she has no where to take her pigs for slaughter, her grain to be milled or her tomatoes to be "sauced".

Small-scale, certified community kitchens, like this one in Montana or this one in Tennessee, are beginning to fill some of this need. There are a few mobile slaughter facilities gaining traction, but not enough to meet demand and too new to measure their long term viability. Not many community colleges offer classes on how to humanely kill and butcher an animal anymore. In the Midwest where I live, there used to be a local "meat locker" in every small town - now there are hardly any. How will we supply the food system with local meat or local flour if there the nearest facility is too far away or doesn't exist at all?

I believe the answer lies in the example we have set for ourselves with beginning farmers. Society is beginning to see farming as a dignified and profitable profession again, and with that comes market demand for good farmers, respect for the profession, government programs to encourage new farmers, and training and educational opportunities. We need similar opportunities for small-scale butchers, millers, bakers and other types of processors.

Local food distribution has received even less attention than processing, and it is a complex piece of the food chain we'll have to get creative about if local food will be available in grocery stores. In Nebraska where I live, the distributor serving most of the rural grocery stores has a weekly buying minimum. A grocer won't even consider buying produce from a local farmer if it will put them below their minimum because the distributor levies a fine.

Challenges like buying minimums and aggregating products from multiple farms crop up when dealing with local foods. Some models are attempting to overcome these challenges, but we'll need more ideas to fit the diversity of situations in which they arise.

Retailing healthy, affordable food has also gained attention lately in the term "food desert", but it's an issue worth repeating. We all need a grocery store nearby, unless you are one of the few that produce all your own food. Without a grocery store, people will not want to live in our communities and neighborhoods, which makes them less vibrant and more vulnerable to failure. Grocery stores are more than food retail, however - they are often the focal point of a town or neighborhood where people go to see friends, swap recipes and catch up on local gossip.

Local ownership of a grocery is critical so that food dollars continue to circulate within the community. Additionally, a locally owned grocery store is not only more likely to purchase from a local farmer than a store owned by an impersonal, profit-driven corporation. In order to have more local grocers, we need to teach young people entrepreneurship in addition to community pride and loyalty. Again, our treatment of beginning farmers gives us a good example of policy solutions to encourage more young people to enter the grocery business.

I used to think there were four distinct pieces to a local food system - production, processing, distribution, and retail. Now I realize there is a fifth - community. Without an involved community of customers who believe in what the local farmer, miller, distributor and grocer is doing, none of them will last very long.

Community is important in another sense as well. Most of the farmers who grow our food live in rural places, and they want to live in active, thriving communities too. Therefore, if we care about local food systems, we should all be concerned with the survival of rural communities regardless of where we live. Rural development is often the red-headed stepchild of the Farm Bill, receiving little attention and even less funding. For local food to expand, we need to give respect and resources to rural communities and their residents.

If growing a local food system is our goal, it must begin with vibrant communities, then follow with genuine opportunities for careers everywhere in the food chain. Expanding our policy solutions beyond producers will help the idea of local food move forward from a trend to a permanent fixture of our food system.

Health Care Knows No Borders

By Angel Romero Kiester
(Editor's note: Angel is current our Rural Health Care Intern)

Last week, I was blessed to have spent a week in Alaska to celebrate a wedding. I know, Alaska in December. It was beautiful, and even though the temp read -37, it seemed much warmer. On my trip I sparked up conversation with the people I encountered. They would start with "Where are you from?" and "What is it that you do?" Of course, I explained what we at the Center do. Not surprisingly at all, I was taken in quite well. The heavily rural areas of Alaska are dealing with the same rural issues we do here in Nebraska.

It was easy to engage them because of all we had in common as rural residents, and really made me feel proud of what we are doing here at the Center. We are not alone in our struggles, and our work stretches beyond the boarders of Nebraska.

Alaska's rural population has it pretty tough due to the geography and climate, which makes access to several things difficult. Similar to us in Nebraska, access to health care is a big problem. Alaska has territory barriers that determine where you can go for medical care. If you are on one side of the line, you go to Fairbanks, and the other you go to Anchorage. In a state that is quite large this can be a major issue.

For instance, one of the couples I met told me how they were sight-seeing thirty minutes from their town, but crossed the line for care territory. She fell and needed medical attention, and had to wait two hours for a transport to the hospital. When her husband needed hip surgery later, they will have to go back to his state of Kentucky because of the long wait in the two hospitals equipped to preform it in Alaska. "Even though we have insurance, the access to medical care is a problem we all struggle with here." said Sharon Wilson of North Pole Alaska. "In the more rural areas, I can't even imagine what they have to go though."

Like Sharon and her husband Bobby, most of the people I talked to were unaware of the good that rural Americans can get out of health care reform. But once they learn of the benefits, they are quick to accept reform.

In a year, after all the rumors that have been debunked, the benefits of health care reform will be more well known. So, in light of all the negative media that continues to bombard us, we all must continue to use the power of our collective voices. I tried to do my part to spread the good word and inform those I met in Alaska. Hopefully they will do the same, and you will too.

Two Bars, a Post Office and an Elevator

When My co-worker sent around this article about the elderly in rural America, I couldn't help but nod my head in agreement. Although the article highlights the difficult points of growing old in rural areas, I still get tremendous amounts of hope and inspiration from talking with older people from small towns. 

When I hear about the busy main streets and late nights on the town of days past, of families making a living on smaller acreages, and good jobs in small towns, I am hopeful that we can rebuild rural areas to something that resembles what my grandparents describe.

Today, living outside of Craig, Nebraska, a town of 220 about 60 miles northwest of Omaha, is hard even for this 23 year old. Craig, now home to two bars, a post office and an elevator, once had a gas co-op and service station, a grocery store, a hardware store, a doctor's office, several cafes, a roller rank and dance hall, and a lumber yard.

In the early 1900's an initiative called the "Craig Improvement Association" worked to bring new businesses to town. They successfully brought an electric shop to Main street along with a few other businesses.

It's been decades since a new business opened on Main Street. Yet, I love this town. Maybe it's the old water tower, the husker-game pot lucks at the bar or the pretty rolling hills East of town. While I don't think Craig will ever have a roller rank and dance hall again, I'd love to see a good breakfast place where you can get a good cup of coffee and read the paper.